Very advanced maternal age and morbidity in Victoria, Australia: a population based study

BMC Pregnancy and Childbirth

Michelle Kealy²  Maryanne Biro¹  Mary-Ann Davey²  Mary C Carolan³ 

[1] School of Nursing and Midwifery, Monash University, Clayton Campus, Wellington Road, Clayton 3800, Australia;Mother and Child Health Research, La Trobe University, Melbourne, Australia;School of Nursing and Midwifery, Victoria University, St Alban’s Campus, PO Box 14228, Melbourne 8001, Australia

关键词: Haemorrhage;    Preterm birth;    Low birth weight;    Very advanced maternal age;    Perinatal death;   

Others  :  1138120
DOI  :  10.1186/1471-2393-13-80

 received in 2012-11-06, accepted in 2013-03-14,  发布年份 2013

【 摘 要 】

Background

In Australia, approximately 0.1% of births occur to women 45 years or older and this rate has been increasing in recent years. There are however, few population based studies examining perinatal outcomes among this age group. The aim of this study was to determine the maternal and perinatal outcomes of pregnancies in women aged 45 years or older compared to women aged 30–34 years.

Methods

Data on births at 20 or more weeks’ gestation were obtained from the Victorian Perinatal Data Collection for the years 2005 and 2006. We examined selected maternal and perinatal outcomes for women of very advanced maternal age (VAMA) aged 45 years or older (n = 217) and compared them to women aged 30–34 years (n = 48,909). Data were summarised using numbers and percentages. Categorical data were analysed by Chi-square tests and Fisher’s exact test. Comparisons are presented using unadjusted odds ratios, 95 percent confidence intervals (CIs) and p-values.

Results

Women aged 45 years and older had higher odds of gestational diabetes (OR 2.05; 95% CI 1.3–3.3); antepartum haemorrhage (OR 1.89; 95% CI 1.01–3.5), and placenta praevia (OR 4.88; 95% CI 2.4–9.5). The older age-group also had higher odds of preterm birth between 32–36 weeks (OR 2.61; 95% CI 1.8–3.8); low birth-weight (<2,500 gr) (OR 2.22; 95% CI 1.5–3.3) and small for gestational age (OR 1.53; 95% CI 1.0–2.3). Stratified analysis revealed that VAMA was most strongly associated with caesarean section in primiparous women (OR 8.24; 95% CI 4.5, 15.4) and those using ART (OR 5.75; 95% CI 2.5, 13.3), but the relationship persisted regardless of parity, ART use and plurality. Low birthweight was associated with VAMA only in first births (OR 3.90; 95% CI 2.3, 6.6), while preterm birth was more common in older women for both first (OR 3.13; 95% CI 1.8, 5.3) and subsequent (OR 2.08; 95% CI 1.2, 3.5) births, and for those having singleton births (OR 2.11; 95% CI 1.3, 3.4), and those who did not use ART (OR 2.10; 95% CI 1.3, 3.4). Preterm birth was very common in multiple births and following ART use, regardless of maternal age.

Conclusions

This study demonstrates that women aged 45 years and older, in Victoria, Australia, have higher rates of pregnancy and perinatal complications, compared to women aged 30–34 years.

【 授权许可】

   
2013 Carolan et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]ABS: Australian Bureau of Statistics: Births Australia 2009, 3301.0 DO007. Canberra: Australian Government Press; 2009.
• [2]Bréart G, Barros H, Wagener Y, Prati S: Characteristics of the childbearing population in Europe. Eur J Obstet Gynecol Reprod Biol 2003, 111(Supplement 1):S45-S52.
• [3]Ventura SJ, Joyce MA, Abma C, Mosher WD, Henshaw SK: National Vital Statistics Reports 58(4), Estimated Pregnancy Rates for the United 1990–2005: An Update. Hyattsville, MD: National Center for Health Statisitcs; 2009.
• [4]Blickstein I: Motherhood at or beyond the edge of reproductive age. Int J Fertil Womens Med 2003, 48(1):17-24.
• [5]Krieg SA, Henne MB, Westphal LM: Obstetric outcomes in donor oocyte pregnancies compared with advanced maternal age in in vitro fertilization pregnancies. Fertil Steril 2008, 90(1):65-70.
• [6]Callaway LK, Lust K, McIntyre HD: Pregnancy outcomes in women of very advanced maternal age. Aust N Z J Obstet Gynaecol 2005, 45(1):12-16.
• [7]Spandorfer SD, Bendikson K, Dragisic K, Schattman G, Davis OK, Rosenwaks Z: Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes. Fertil Steril 2007, 87(1):74-76.
• [8]Glasser S, Segev-Zahav A, Fortinsky P, Gedal-Beer D, Schiff E, Lerner-Geva L: Primiparity at very advanced maternal age (≥45 years). Fertil Steril 2011, 95(8):2548-2551.
• [9]Dildy GA, Jackson GM, Fowers GK, Oshiro BT, Varner MW, Clark SL: Very advanced maternal age: Pregnancy after age 45. Am J Obstet Gynecol 1996, 175(3 PART I):668-674.
• [10]Dulitzki M, Soriano D, Schiff E, Chetrit A, Mashiach S, Seidman DS: Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery. Obstet Gynecol 1998, 92(6):935-939.
• [11]Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A: Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 2010, 203(6):558. e1–7
• [12]Flenady V, Koopmans L, Middleton P, Froen JF, Smith GC, Gibbons K: Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011, 377(9774):1331-1340.
• [13]Balayla J, Azoulay L, Assayag J, Benjamin A, Abenhaim HA: Effect of maternal age on the risk of stillbirth: a population-based cohort study on 37 million births in the United States. Am J Perinatol 2011, 28(8):643-650.
• [14]Fretts RC, Schnittdiel J, McLean FH, Usher RH, Goldman MB: Increased maternal age and the reisk of fetal death. JAMA 1995, 333(15):953-957.
• [15]Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R: The perinatal effects of delayed childbearing. Obstet Gynecol 2005, 105(6):1410-1418.
• [16]Paulson RJ, Boostanfar R, Saadat P, Mor E, Tourgeman DE, Slater CC: Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age. J Am Med Assoc 2002, 288(18):2320-2323.
• [17]Hossain N, Khan N, Khan NH: Obstetric causes of stillbirth at low socioeconomic settings. J Pak Med Assoc 2009, 59(11):744-747.
• [18]Minogue M: Childbearing at 45 and over. Ir Med J 1976, 69(20):526-528.
• [19]Abu-Heija AT, Jallad MF, Abukteish F: Maternal and perinatal outcome of pregnancies after the age of 45. J Obstet Gynaecol Res 2000, 26(1):27-30.
• [20]Stephansson O, Dickman PW, Johansson ALV, Cnattingius S: The influence of socio-economic status on stillbirth risk in Sweden. Int J Epidemiol 2001, 30:1296-1301.
• [21]Goy J, Dodds L, Rosenberg MW, King WD: Health-risk behaviours: Examining social disparities in the occurrence of stillbirth. Paediatr Perinat Epidemiol 2008, 22(4):314-320.
• [22]Biro MA, Davey M-A, Carolan M, Kealy M: Advanced maternal age and obstetric morbidity for women giving birth in Victoria, Australia: a population-based study. Aust N Z J Obstet Gynaecol 2012, 52(3):229-234.
• [23]ABS: Australian Bureau of Statistics: Perinatal Deaths, Australia, 2008, 3304.0. Canberra: Australian Government Press; 2008.
• [24]Roberts CL, Lancaster PA: National birthweight percentiles by gestational age for twins born in Australia. J Paediatr Child Health 1999 Jun, 35(3):278-282.
• [25]Roberts CL, Lancaster PA: Australian national birthweight percentiles by gestational age. Med J Aust 1999 Feb 1, 170(3):114-118.
• [26]CCOPMM: The Consultative Council on Obstetric and Paediatric Mortality and Morbidity: Annual Report for the Year 2008, incorporating the 47th Survey of Perinatal Deaths in Victoria. Melbourne, Victoria: Department of Health; 2011.
• [27]IBM SPSS Statistics 19: Release Version 19.0.0. Chicago, IL: D3 SPSS, Inc; 2009. [http://www.spss.com webcite]
• [28]ABS: Australian Bureau of Statistics: 4102.0-Australian Social Trends. Australia’s Babies Canberra: Australian Government Press; 2007.
• [29]Hammarberg K, Clarke VE: Reasons for delaying childbearing-a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician 2005, 34(3):187-189.
• [30]Carolan M, Frankowska D: Advanced maternal age and adverse perinatal outcome: A review of the evidence. Midwifery 2011, 27(6):793-801.
• [31]Kale A, Kuyumcuoglu U, Guzel A: Is pregnancy over 45 with very high parity related with adverse maternal and fetal outcomes? Clin Exp Obstet Gynecol 2009, 36(2):120-122.
• [32]Shrim A, Levin I, Mallozzi A, Brown R, Salama K, Gamzu R, Almog B: Does very advanced maternal age, with or without egg donation, really increase obstetric risk in a large tertiary center? J Perinat Med 2010, 38(6):645-650.
• [33]Antinori S, Gholami GH, Versaci C, Cerusico F, Dani L, Antinori M: Obstetric and prenatal outcome in menopausal women: a 12-year clinical study. Reprod Biomed Online 2003, 6(2):257-261.
• [34]Hutcheon JA, Lisonkova S, Joseph KS: Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011, 25(4):391-403.
• [35]AIHW: Australian Institute of Health and Welfare: 2005–2006. Gestational diabetes in Australia. Canberra: Australian Government Press; 2008.
• [36]Vazquez Rodriguez A, Tur Padro R, Martinez San Andres F, Mateo Lopez L, Coroleu Lletget B, Comas Gabriel C: Influence of age and assisted reproductive techniques in obstetric and perinatal outcomes. Progresos de Obstetricia y Ginecologia 2010, 53(10):391-398.
• [37]Rath W, Schneider M: Definitions and diagnosis of postpartum haemorrhage (PPH): underestimated problems! Geburtshilfe Frauenheilkd 2010, 70(1):36-40.
• [38]Cameron C, Roberts CL, Olive EC, Ford JB, Fischer WE: Trends in postpartum haemorrhage. Aust N Z J Public Health 2006, 30(2):151-156.
• [39]Laws P, Sullivan EA: Australia’s mothers and babies 2007. Sydney: Australian Institute of Health and Welfare; 2009.
• [40]Carolan M, Davey M-A, Biro MA, Kealy M: Older maternal age and intervention in labor: a population-based study comparing older and younger first-time mothers in Victoria, Australia. Birth 2011, 38(1):24-29.
• [41]Jacobsson B, Ladfors L, Milsom I: Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004, 104(4):727-733.
• [42]Simchen MJ, Yinon Y, Moran O, Schiff E, Sivan E: Pregnancy outcome after age 50. Obstet Gynecol 2006, 108(5):1084-1088.
• [43]Usta IM, Nassar AH: Advanced maternal age. Part I: obstetric complications. Am J Perinatol 2008, 25(8):521-534.
• [44]Cano F, Simon C, Remohi J: Pellicer A; Effect of aging on the female reproductive system: evidence for a role of uterine senescence in the decline in female fecundity. Fertil Steril 1995, 64(3):584-589.
• [45]Gielen M, Van Beijsterveldt CEM, Derom C, Vlietinck R, Nijhuis JG, Zeegers MPA, Boomsma DI: Secular trends in gestational age and birthweight in twins. Hum Reprod 2012, 25(9):2346-2353.
• [46]Keirse MJ, Hanssens M, Devlieger H: Trends in preterm births in Flanders, Belgium, from 1991 to 2002. Paediatr Perinat Epidemiol 2009, 23(6):522-532.
• [47]Delbaere I, Verstraelen H, Goetgeluk S, Martens G, Derom C, De Bacquer D, De Backer G, Temmerman M: Perinatal outcome of twin pregnancies in women of advanced age. Hum Reprod 2008, 23(9):2145-2150.
• [48]Kathiresan ASQ, Roca LE, Istwan N, Desch C, Cordova YC, Tudela FJ, Gonzalez-Quintero VH: The influence of maternal age on pregnancy outcome in nulliparous women with twin gestation. Am J Perinatol 2011, 28(5):355-359.
• [49]Fox NS, Rebarber A, Dunham SM, Saltzman DH: Outcomes of multiple gestations with advanced maternal age. J Matern Fetal Neonatal Med 2009, 22(7):593-596.
• [50]Lisonkova S, Sheps SB, Janssen PA, Lee SK, Dahlgren L: Effect of older maternal age on birth outcomes in twin pregnancies: a population-based study. J Perinatol 2011, 31(2):85-91.
• [51]Kristensen S, Salihu HM, Keith LG, Kirby RS, Pass MAB, Fowler KB: Impact of advanced maternal age on neonatal survival of twin small-for-gestational-age subtypes. J Obstet Gynaecol Res 2007, 33(3):259-265.
• [52]Davey M-A, Taylor O, Oats JJN, Riley M: Births in Victoria 2005 and 2006. Melbourne: Victorian Perinatal Data Collection Unit, Department of Human Services, Statewide Quality Branch, Department of Human Services; 2008.